scholarly journals Effects of Preoperative Skin Preparation on Postoperative Wound Infection Rates A Prospective Study of 3 Skin Preparation Protocols

2009 ◽  
Vol 30 (10) ◽  
pp. 964-971 ◽  
Author(s):  
Brian R. Swenson ◽  
Traci L. Hedrick ◽  
Rosemarie Metzger ◽  
Hugo Bonatti ◽  
Timothy L. Pruett ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
General Surgery ◽  
Isopropyl Alcohol ◽  
Povidone Iodine ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Skin Preparation ◽  
Improvement Project ◽  
Period 2

Objective.To compare the effects of different skin preparation solutions on surgical-site infection rates.Design.Three skin preparations were compared by means of a sequential implementation Design. Each agent was adopted as the preferred modality for a 6-month period for all general surgery cases. Period 1 used a povidone-iodine scrub-paint combination (Betadine) with an isopropyl alcohol application between these steps, period 2 used 2% Chlorhexidine and 70% isopropyl alcohol (ChloraPrep), and period 3 used iodine povacrylex in isopropyl alcohol (DuraPrep). Surgical-site infections were tracked for 30 days as part of ongoing data collection for the National Surgical Quality Improvement Project initiative. The primary outcome was the overall rate of surgical-site infection by 6-month period performed in an intent-to-treat manner.Setting.Single large academic medical center.Patients.All adult general surgery patients.Results.The study comprised 3,209 operations. The lowest infection rate was seen in period 3, with iodine povacrylex in isopropyl alcohol as the preferred preparation method (3.9%, compared with 6.4% for period 1 and 7.1% for period 2; P = .002). In subgroup analysis, no difference in outcomes was seen between patients prepared with povidone-iodine scrub-paint and those prepared with iodine povacrylex in isopropyl alcohol, but patients in both these groups had significantly lower surgical-site infection rates, compared with rates for patients prepared with 2% Chlorhexidine and 70% isopropyl alcohol (4.8% vs 8.2%; P = .001).Conclusions.Skin preparation solution is an important factor in the prevention of surgical-site infections. Iodophor-based compounds may be superior to Chlorhexidine for this purpose in general surgery patients.

scholarly journals Does Skin Preparation Influence Surgical Site Infection in Laparotomy Wounds: Comparative Evaluation of Preoperative Skin Preparation With 4% Chlorhexidine With 5% Povidone Iodine in Laparotomy Wounds: A Prospective Trial

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Ravindran Chirukandath ◽  
Manoj P. Elangovan ◽  
Agil B. ◽  
Reshma A. Cheedhamadathil ◽  
Ayana M. Dev ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Povidone Iodine ◽  
Prospective Trial ◽  
Surgical Site Infections ◽  
P Value ◽  
Site Infection ◽  
Related Complication ◽  
Skin Preparation ◽  
Emergency Procedures ◽  
Significant Difference

Introduction: Surgical site infection is a dangerous condition causing a heavy burden on the patient and social health system. Surgical site infections are among the most common hospital acquired infections comprising 14 to 16% of inpatient infections. There are various factors predisposing the infections and many of them are patient related or disease related. The use of pre-operative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. There are several kinds of antiseptics available for preoperative skin preparation; however povidone iodine and spirit are commonly used in clinical practice. Materials and Methods: This study compared the incidence of surgical site infections within 7 days of postoperative period in laparotomy wounds prepared using 4% Chlorhexidine and those prepared with 5% Povidone iodine for pre-laparotomy skin preparation. Results: This study compared 128, 4% Chlorhexidine prepared patients and 109,  5% Povidone iodine prepared patients undergoing various elective n = 114 and emergency procedures n = 123. The overall SSI rates in 7 days in the whole group were 13.44 %. The SSI rates on the 4% Chlorhexidine group were 10.16% and 5% povidone iodine group were 17.27% and it was statically significant with a p value of p = 0.00413 showing significant reduction in the 4% Chlorhexidine group. The study also compared the SSI rates in elective and emergency procedures in both groups with significant difference in emergency procedures. More variables are also compared between the groups and results were analyzed. Conclusion: This study shows the use of Chlorhexidine 4% reduces the morbidity of one of the most common wound related complication in laparotomy patients in all categories of laparotomy wounds.

58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Mistry ◽  
B Woolner ◽  
A John
Keyword(s):  
Surgical Site Infection ◽  
Open Cholecystectomy ◽  
Surgical Site Infections ◽  
Standard Operating Procedure ◽  
Site Infection ◽  
Infection Rates ◽  
Local Evidence ◽  
Audit Data ◽  
The Impact ◽  
To Receive

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.

Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

2006 ◽  
Vol 27 (12) ◽  
pp. 1358-1365 ◽  
Author(s):  
Marisa I. Gómez ◽  
Silvia I. Acosta-Gnass ◽  
Luisa Mosqueda-Barboza ◽  
Juan A Basualdo
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Final Stage ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Prospective Survey ◽  
Surgical Antibiotic Prophylaxis ◽  
Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

scholarly journals Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England

2019 ◽  
Vol 101 (7) ◽  
pp. 463-471
Author(s):  
JLC Wong ◽  
CWY Ho ◽  
G Scott ◽  
JT Machin ◽  
TWR Briggs ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
National Survey ◽  
Financial Burden ◽  
Surgical Site Infections ◽  
Paediatric Surgery ◽  
Site Infection ◽  
Infection Rates ◽  
Infection Surveillance ◽  
Surgical Units ◽  
First Time

Introduction Surgical site infections are associated with increased morbidity and mortality in patients. The Getting It Right First Time surgical site infection programme set up a national survey to review surgical site infection rates in surgical units in England. The objectives were for frontline clinicians to assess the rates of infection following selected procedures, to examine the risk of significant complications and to review current practice in the prevention of surgical site infection. Methods A national survey was launched in April 2017 to assess surgical site infections within 13 specialties: breast surgery, cardiothoracic surgery, cranial neurosurgery, ear, nose and throat surgery, general surgery, obstetrics and gynaecology, ophthalmology, oral and maxillofacial surgery, orthopaedic surgery, paediatric surgery, spinal surgery, urology and vascular surgery. All participating trusts prospectively identified and collected supporting information on surgical site infections diagnosed within the six-month study period. Results Data were received from 95 NHS trusts. A total of 1807 surgical site infection cases were reported. There were variations in rates reported by trusts across specialties and procedures. Reoperations were reported in 36.2% of all identified cases, and surgical site infections are associated with a delayed discharge rate of 34.1% in our survey. Conclusion The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England.

scholarly journals MRSA – ‘Bug-Bear’ of a Surgical Practice: Reducing the Incidence of MRSA Surgical Site Infections

2006 ◽  
Vol 88 (2) ◽  
pp. 222-223 ◽  
Author(s):  
Andrea Guyot ◽  
Graham Layer
Keyword(s):  
Staphylococcus Aureus ◽  
Surgical Site Infection ◽  
Orthopaedic Surgery ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Methicillin Resistant ◽  
Surgical Practice ◽  
Department Of Health

Adverse publicity (the ‘superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied (< http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsStatistic > 28 October 2005). Infection rates were generally and gratifyingly low but 48% of surgical site infections were caused by Staph. aureus and of those 68% were MRSA. The following article will discuss the aetiology and prevention of MRSA surgical site infection.

Preventing surgical site infection: conclusions from experts at EWMA

2019 ◽  
Vol 28 (7) ◽  
pp. 466-468
Keyword(s):  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Opinion Leaders ◽  
Site Infection ◽  
Infection Rates ◽  
Key Opinion Leaders

In an Essity-sponsored symposium, titled ‘Surgical site infection rates still high? We need to do more,’ key opinion leaders discussed the importance of identifying, preventing and treating surgical site infections (SSI). Fatima Bibi summarises the main points presented at EWMA 2019.

Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

2006 ◽  
Vol 27 (12) ◽  
pp. 1358-1365 ◽  
Author(s):  
Marisa I. Gómez ◽  
Silvia I. Acosta-Gnass ◽  
Luisa Mosqueda-Barboza ◽  
Juan A Basualdo
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Final Stage ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Infection Rates ◽  
Prospective Survey ◽  
Surgical Antibiotic Prophylaxis ◽  
Surgical Antimicrobial Prophylaxis

Objective.To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.Design.An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.Setting.An 88-bed teaching hospital in Entre Ríos, Argentina.Patients.A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.Results.Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30];P&lt; .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55];P&lt; .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84];P&lt; .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79];P&lt; .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89];P&lt;.01).Conclusion.The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

Optimal Approaches to Skin Preparation Prior to Neurosurgery

US Neurology ◽  
2010 ◽  
Vol 06 (02) ◽  
pp. 14
Author(s):  
Vishad Sukul ◽  
Tamara Lynch ◽  
Christopher M Loftus ◽  
◽  
◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Site Infection ◽  
Skin Preparation ◽  
Operative Site ◽  
Incision Site ◽  
Neurosurgical Patient ◽  
Surgical Infections ◽  
The World ◽  
Infection Spread

Surgical site infections have always been and will likely remain a significant concern for physicians around the world. When almost 40% of nosocomial surgical infections are related to the incision site, appropriate preperation of the skin becomes a particular concern. Neurosurgery is no stranger to surgical site infection. Infections of this type in the neurosurgical patient can have serious, long-lasting consequences should infection spread deeper than skin level. In this article, the current recommendations for skin preparation at the start of surgery are reviewed, taking into account specific considerations that must be made for the neurosurgical patient. In addition, the use of adjunct methods, i.e. antibiotic-impregnated drapes, and the effects of clipping versus shaving hair at the operative site are discussed.

scholarly journals A comparative study between povidone iodine and metronidazole for peritoneal lavage in cases of peritonitis

2019 ◽  
Vol 6 (4) ◽  
pp. 1214
Author(s):  
Asadulla Baig ◽  
Mohan Kumar K.
Keyword(s):  
Surgical Site Infection ◽  
Peritoneal Lavage ◽  
Povidone Iodine ◽  
Randomized Study ◽  
Surgical Site Infections ◽  
Colony Count ◽  
Site Infection ◽  
Bacterial Colony ◽  
Female Ratio ◽  
Male Female Ratio

Background: Peritonitis secondary to hollow viscous perforation is one of the commonest emergencies encountered in general surgical practice. This randomized study aimed to compare the efficiency of Povidone iodine and Metronidazole in these cases by quantitative analysis of bacterial colony count in patients who have received peritoneal lavage with either of them.Methods: A total of 100 consecutive patients who presented with peritonitis secondary to hollow viscous perforation were enrolled in this study (February 2010 to February 2011) and systematically divided into 2 groups: peritoneal lavage with povidone iodine group and lavage with metronidazole group. The post-operative progress was assessed by comparing the pre-wash and post wash colony counts in both the groups, development of surgical site infection and duration of hospital stay.Results: The median age of the patients was 33 years (range: 12-75 years), with a male: female ratio of 3.8:1. Perforation of duodenal ulcer (67%) was the commonest cause of peritonitis with E. coli (65%) being the commonest organism isolated from the peritoneal fluid. Reduction in bacterial colony count was seen in both the groups of patients, however, there was significantly greater reduction in the patients who received lavage with Metronidazole (p=0.06). Incidence of surgical site infection was less in the Povidone iodine group though it did not reach statistical significance.Conclusions: The use of povidone iodine in peritoneal lavage significantly reduce the bacterial colony and may also result in fewer surgical site infections.

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